Authorization of Background Check

Authorization of Background Check
PLEASE DO NOT FILL IN AS ANONYMOUS. Please read and fill out the following form. Your written authorization is necessary for completion of the application process. A passing background check is mandatory in order to complete the application process for The DoSeum Volunteer Program. The DoSeum has attained a level of public trust to which every partner contributes and for which every partner is responsible. As part of our ongoing efforts to find and retain volunteers who are mindful of this responsibility, we may from time to time perform or request that an outside agency perform a consumer report and/or investigative consumer report with the volunteer’s consent. During or prior to your volunteer services, The DoSeum and/or its affiliates may also conduct an investigation concerning, and/or obtain from a consumer reporting agency a consumer report concerning your character, general reputation, personal characteristics, and mode of living, for the purposes of volunteering. By your signature below, you are affirmatively authorizing The DoSeum and/or its affiliates to request and use your consumer report or investigative consumer report for the purposes of volunteering at The DoSeum. * Disclaimer: Because databases are used in this process, date of birth and ID numbers are required as an identifier of individuals who may have the same or similar names. DOB and ID # are requested as an identifier to obtain this report and will not be used for any other reason during the selection process and will not appear on any other application document. PLEASE DO NOT FILL IN AS ANONYMOUS.

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Your Information

First Name *

Last Name *

Email Address *

Phone Number

Full Name *

Full name of the potential volunteer.

Phone Number *

DOB

* Date Of Birth MM/DD/YYYY

Address *

ID Type *

Please select one

State Drivers License
State ID
Military ID
Passport Number

Driver's License, State Issued ID or Military ID Number *

Please be sure to insert the correct ID number. This is mandatory to process the background check.

Initial Here *

I,____, hereby authorize The DoSeum to investigate my background and qualifications for purpose of evaluating whether I am qualified for volunteering purposes only. I understand that The DoSeum will utilize an outside firm or firms to assist it in checking such information, and I specifically authorize such as investigation by information services and outside entities of the company's choice. I also understand that I may withhold my permission and that in such a case, no investigation will be done, and my application to volunteer will not be processed further.

Are you with a group? *

If No, please type NO. If yes, please name the group/organization you are with.

Your Information

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